Standard form for the notification of Home Member State
1.* / Issuer Name:1.bis. / Formerly known asi:
2.* / Registered office:
3. / LEIii:
3.bis / National company register numberiii:
4.* / Home Member Stateiv:
5.* / Triggering eventv:
Issuer of shares admitted to trading / article 2(1)(i)(i)
Issuer of debt securities denominated less than EUR 1,000 admitted to trading / article 2(1)(i)(i)
Issuer of other securitiesvi / article 2(1)(i)(ii)
Change of home Member State / article 2(1)(i)(iii)
6.* / Member State(s) where the issuer's securities are admitted to tradingvii:
Shares / Debt securities < 1000€ / Other securities
Austria
Belgium
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Liechtenstein
Lithuania
Luxembourg
Malta
Netherlands
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
Sweden
United Kingdom
6. bis. / Former home Member State (if applicable)viii:
7. NCAs the form is required to be filed withix:
8*. / Date of notification:9. / Start date of 3 year periodx:
10. / Additional informationxi :
11.* / Contact details:
Issuer’s address:
Person responsible within the issuer for the present notification: / Person responsible within the issuer for the present notification:
E-Mail address:
Telephone:
(* Mandatory information)
Information on filing procedures:
Austria / e-mail to:Belgium / e-mail to:
Bulgaria
Croatia / via national OAM: SRPI; or postal address: Miramarska 24b, 10000 Zagreb, Croatia
Cyprus / e-mail to: (to the attention of Issuers Department)
Czech Republic / vianational OAM:
http://www.cnb.cz/en/supervision_financial_market/information_published_issuers/index.html
Denmark / website: http://oasm.dfsa.dk/
Estonia / e-mail to:
Finland / e-mail to:
France / via: https://onde.amf-france.org/RemiseInformationEmetteur/Client/PTRemiseInformationEmetteur.aspx
Germany / e-mail to:
Greece / e-mail to:
Hungary / e-mail to:
Iceland / via national OAM: www.oam.is
Ireland / e-mail to:
Italy / e-mail to:
Latvia / e-mail to: or postal address: Kungu iela 1, Riga, Latvia, LV-1050
Liechtenstein
Lithuania / e-mail to:
Luxembourg / e-mail to:
Malta
Netherlands / e-mail to:
Norway
Poland / e-mail to: or via ESPI system
Portugal / e-mail to:
Romania / e-mail to
Slovakia / via national OAM: https://ceri.nbs.sk/
Slovenia / e-mail to:
Spain / online register: https://sede.cnmv.gob.es/sedecnmv/SedeElectronica.aspx?lang=en
Sweden / e-mail to:
United Kingdom / e-mail to:
Notes:
i In case of a change of the company name compared to the previous disclosure, please provide the issuer’s former company name. In case of a first time disclosure, no information on an earlier name change is required.
ii Legal entity identifier.
iii In case the LEI is unavailable, please provide for identification purposes the number under which the issuer is registered with the business register of its country of incorporation.
iv The home Member State pursuant to article 2(1)(i) of Directive 2004/109/EC.
v The criteria upon which the home Member State has been determined.
vi For example debt securities denominated at least EUR 1,000, units of collective investment undertaking of the closed end- type.
vii Only securities admitted to trading on regulated markets shall be taken into account.
viii Information required in case the issuer chooses a new home Member State pursuant to article 2(1)(i)(iii).
Ix According to article 2(1)(i), second subparagraph of Directive 2004/109/EC.
x In case of a choice of home Member State pursuant to article 2(1)(i)(ii) of Directive 2004/109/EC.
xi Please provide any relevant additional information.
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